二维超声联合三维血管成像对慢性子宫内膜炎的诊断价值

Diagnostic value of two-dimensional ultrasound combined with three-dimensional angiography in chronic endometritis

摘要

目的 探讨经阴道二维超声联合三维能量多普勒血管成像(3D-PDA)检查子宫内膜对慢性子宫内膜炎(CE)的诊断价值。方法 选取2023年1月至2023年8月西安市第四医院收治的210例女性患者作为研究对象,均行经阴道超声及宫腔镜检查,以病理诊断结果为标准,分为CE组(n=119)和无CE的对照组(n=91),比较两组经阴道二维超声检查的子宫内膜厚度、回声均匀性、子宫内膜Applebaum分型情况,以及3D-PDA检查的子宫内膜血流参数,包括血管化指数(VI)、血流指数(FI)及血管-血流指数(VFI)。采用受试者工作特征(ROC)曲线分析子宫内膜厚度、回声均匀性、子宫内膜Applebaum分型、VI、FI、VFI对CE的诊断价值。结果 CE组子宫内膜厚度、Ⅱ型及Ⅲ型血流占比、VI、FI、VFI均小于对照组,内膜回声不均匀占比、Ⅰ型血流占比均多于对照组(t/χ²值介于-2.831~89.249之间,P<0.05)。ROC曲线分析显示,子宫内膜厚度、内膜回声均匀性、VI、FI、VFI五项联合检测的诊断价值最高,AUC值为0.942,灵敏度87.90%,特异度为79.50%。结论 经阴道二维超声联合三维能量多普勒血管成像检查子宫内膜对CE的诊断价值较高,可作为一种无创性的临床诊断方法推广使用。

Abstract

Objective To explore the diagnostic value of transvaginal two-dimensional ultrasound combined with three-dimensional power Doppler angiography (3D-PDA) in evaluating the endometrium for chronic endometritis (CE). Methods A total of 210 female patients admitted to the Xi′an Fourth Hospital were selected as the study objects. They all underwent transvaginal ultrasound and hysteroscopy examinations, and were divided into chronic endometritis group (CE group, n=119 cases) and non-chronic endometritis group (control group, n=91 cases) according to the pathological diagnosis results. Endometrial thickness, echo uniformity, endometrial applebaum typing detected by two-dimensional ultrasound and endometrial blood flow parameters, including vascularization index (VI), blood flow index (FI) and vascular-flow index (VFI) detected by 3D-PDA were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was used to analyze the diagnostic value of endometrial thickness, echo uniformity, endometrial applebaum typing, VI, FI and VFI in CE. Results The endometrial thickness, proportion of type Ⅱ and type Ⅲ blood flow, VI, FI and VFI in the CE group were all lower than those in control group, the proportion of heterogeneous endometrial echogenicity and type Ⅰ blood flow in CE group was higher than that in control group (t/χ² values ranged from -2.831 to 89.249, P<0.05). ROC curve analysis showed that the combined detection of endometrial thickness, echo uniformity, VI, FI and VFI had the highest diagnostic value, with an AUC value of 0.942, sensitivity of 87.9% and specificity of 79.5%. Conclusion Transvaginal two-dimensional ultrasound combined with three-dimensional power Doppler angiography for evaluating the endometrium shows a higher diagnostic value for CE. It can be promoted as a non-invasive clinical diagnostic method.

关键词

慢性子宫内膜炎 / 三维能量多普勒血管成像 / 子宫内膜Applebaum分型

Key words

chronic endometritis / three-dimensional power Doppler angiography / endometrial applebaum typing

参考文献

[1] Tsonis O, Gkrozou F, Dimitriou E, et al. Hysteroscopic features suggestive of chronic endometritis: a systematic review[J]. Hum Fertil (Camb), 2023, 26(6): 1530-1543.

[2] Yasuo T, Kitaya K. Challenges in clinical diagnosis and management of chronic endometritis[J]. Diagnostics (Basel), 2022, 12(11): 2711.

[3] Hogen Esch E, Hojjati R, Komorowski A, et al. Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center[J]. J Assist Reprod Genet, 2023, 40(10): 2463-2471.

[4] Qiao X, Wu L, Liu D, et al. Existence of chronic endometritis and its influence on pregnancy outcomes in infertile women with minimal/mild endometriosis[J]. Int J Gynaecol Obstet, 2023, 160(2): 628-634.

[5] 黄千贻, 曾中虹, 杨一华. 慢性子宫内膜炎诊断与治疗的研究进展[J]. 生殖医学杂志, 2023, 32(8): 1275-1279.

[6] Kalmantis K, Daskalakis G, Semertzidou A, et al. The role of three-dimensional power Doppler hysterosonography (3-DPDS) in distinguishing atypical polypoid adenomyomas (APAs) from other intrauterine tumors: correlation with pathologic findings[J]. Arch Gynecol Obstet, 2017, 296(2): 391-396.

[7] 范娜, 周锋, 李晓彦. 三维超声血管血流参数对子宫内膜癌患者腹腔镜治疗预后的评估价值[J]. 实用癌症杂志, 2023, 38(2): 310-312, 319.

[8] 杨凤娜, 魏志玲, 汪娟, 等. 慢性子宫内膜炎诊断的研究进展[J]. 中国计划生育和妇产科, 2023, 15(04): 3-6.

[9] Kitaya K, Takeuchi T, Mizuta S, et al. Endometritis: new time, new concepts[J]. Fertil Steril, 2018, 110(3): 344-350.

[10] 张路, 高彩虹, 包洪初. 生殖道微生物组学与慢性子宫内膜炎的相关性[J]. 国际生殖健康/计划生育杂志, 2023, 42(2): 167-171.

[11] Cheng X, Huang Z, Xiao Z, et al. Does antibiotic therapy for chronic endometritis improve clinical outcomes of patients with recurrent implantation failure in subsequent IVF cycles? A systematic review and meta-analysis[J]. J Assist Reprod Genet, 2022, 39(8): 1797-1813.

[12] Cicinelli E, Matteo M, Trojano G, et al. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception[J]. Am J Reprod Immunol, 2018, 79(1).

[13] 张惠娟, 韩宝生, 苏兴, 等. 宫腔镜检查联合子宫内膜CD38、CD138水平检测对慢性子宫内膜炎的诊断价值研究[J]. 中国计划生育和妇产科, 2023, 15(1): 88-90.

[14] 严罗镓, 金碧辉, 舒静. 慢性子宫内膜炎与女性生殖功能的关系研究进展[J]. 浙江医学, 2022, 44(7): 771-776.

[15] Kimura F, Takebayashi A, Ishida M, et al. Review: Chronic endometritis and its effect on reproduction[J]. J Obstet Gynaecol Res, 2019, 45(5): 951-960.

[16] 陈燕飞. 经阴道超声检查对子宫内膜病变初步诊断的临床价值[J]. 影像研究与医学应用, 2021, 5(21): 11-12.

[17] 白晓慧, 梁碧荣, 杨建享, 闫景彬. 三维能量多普勒超声对不孕症薄型子宫内膜容受性的诊断价值[J]. 中国妇幼健康研究, 2020, 31(3): 360-364.

[18] Akgün Kavurmacı S, Şahin G, Akdogan A, et al. Evaluating the role of endometrial colour Doppler dynamic tissue perfusion measurements in in vitro fertilisation success[J]. J Obstet Gynaecol, 2022, 42(5): 1305-1311.

[19] Zargar M, Ghafourian M, Nikbakht R, et al. Evaluating chronic endometritis in women with recurrent implantation failure and recurrent pregnancy loss by hysteroscopy and immunohistochemistry[J]. J Minim Invasive Gynecol, 2020, 27(1): 116-121.

[20] 张明玮, 刘倩, 谢青贞. 慢性子宫内膜炎对宫腔粘连治疗结局的影响[J]. 生殖医学杂志, 2023, 32(6): 823-828.

[21] Guo J, Li Y, Liu S, et al. High prevalence of chronic endometritis is associated with metabolic abnormality and reduced live birth rate among IVF women with non-uniform endometrial echogenicity[J]. Am J Reprod Immunol, 2023, 90(4): e13771.

[22] 王欣丽, 王蔼明. 子宫内膜炎的超声表现[J]. 母婴世界, 2021,(13): 296-297.

[23] Li Y, Yu S, Huang C, et al. Evaluation of peripheral and uterine immune status of chronic endometritis in patients with recurrent reproductive failure[J]. Fertil Steril, 2020, 113(1): 187-196.e181.

[24] 王玫. 经阴道彩色多普勒超声检测子宫动脉血流参数与受孕的相关性研究[J]. 现代诊断与治疗, 2023, 34(9): 1272-1274.

[25] Zeng S, Liu X, Liu D, et al. Research update for the immune microenvironment of chronic endometritis[J]. J Reprod Immunol, 2022, 152: 103637.

[26] 胡丽琴, 林颖琦, 陈珮怡, 等. 薏苡附子败酱散加味汤联合抗生素治疗慢性子宫内膜炎的疗效及对患者炎症反应的影响[J]. 中国性科学, 2023, 32(5): 131-135.

基金资助

陕西省重点研发计划项目(2023GYBSFG49)

西安市卫生健康委员会科研项目(2022ms04)